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Trending in Telehealth: July 16 – 22, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Professional standards
  • Hospice services
  • Teledentistry

A CLOSER LOOK

Finalized Legislation & Rulemaking:

  • In Alaska, the governor signed SB 91 that impacts out-of-state members of a multi-disciplinary team providing services to a patient located within the state. SB 91 clarifies that the out-of-state members of a multi-disciplinary team are treated the same as out-of-state physicians and it addresses the disciplinary actions that may be imposed.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

  • In New Hampshire, the House passed HB 1095, which standardizes the definition of telemedicine across multiple professions.
  • Ohio proposed two separate substantive rules eliminating the availability of services provided via telehealth. The summaries of the rule changes reference changes in federal policy since the end of the COVID public health emergency as justification for the roll-back, but do not specify the specific policy changes:
    • The first rule relates to Medicaid covered services that hospice providers may or must furnish to the extent specified by the individual’s plan of care. Among the changes to the rule is the removal of language that allows core and non-core services to be provided through a combination of contracting services and telehealth services as necessary.
    • The second rule addresses hospice services and includes among the changes the removal of language that allowed for the reimbursement of telehealth services where in-person visits were otherwise mandated.
  • Washington issued a proposal statement of inquiry regarding a possible rule implementing recent legislation which updated supervision requirements and the scope of practice for medical assistants. The bill lowered the supervision level required for the medical assistant-certified (MA-C) credential and the medical assistant-registered (MA-R) credential to provide treatment for known or suspected syphilis infections from “immediate or direct visual” supervision to “telemedicine” supervision.
  • Nevada proposed a rule establishing permissible services to be provided via teledentistry.

Why it matters:

  • States are focusing on ensuring professional standards for telehealth services. Ohio and Washington are considering proposed rules to adopt additional professional standards and scope of practice regulations concerning various healthcare professionals. Alaska also passed a bill that imposes certain disciplinary guidelines for the improper provision of telehealth services.
  • Teledentistry continues to be adopted by more states. Nevada is considering a proposed rule establishing provisions on teledentistry.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott Digital Health team works alongside the industry’s leading providers, payors and technology innovators to help them enter new markets, break down barriers to delivering accessible care and mitigate enforcement risk through proactive compliance.




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Trending in Telehealth: July 9 – 15, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Insurance and Medicaid reimbursement
  • Speech-language pathology and audiology
  • School-based health services

A CLOSER LOOK

Finalized Legislation & Rulemaking:

  • Florida finalized a rule updating the disciplinary guidelines for the Florida Board of Speech-Language Pathology and Audiology to describe potential disciplinary actions for certain violations by out-of-state telehealth registrants.
  • In Pennsylvania, Senate Bill 74, which was enacted on April 18, 2024, became effective as of July 15, 2024. The bill requires Medicaid coverage for maternity services and health insurance coverage for telehealth and in-home program services for pregnant and postpartum women.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

  • Oregon issued a proposed rule that would update school-based health services to add services and health plans approved by Oregon’s Medicaid State Plan Amendment, including telehealth.

Why it matters:

  • States are increasing access to and coverage for telemedicine services. Pennsylvania expanded access to and coverage of telehealth services for pregnant and postpartum women seeking maternity services. Additionally, Oregon is considering a rule to expand telehealth coverage for school-based health services.
  • Legislation is slowing down for the summer. As typical during the mid to late summer, legislative activity has slowed down across the board, including as related to telehealth.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott Digital Health team works alongside the industry’s leading providers, payors and technology innovators to help them enter new markets, break down barriers to delivering accessible care and mitigate enforcement risk through proactive compliance.




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Trending in Telehealth: July 2 – 8, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Insurance and Medicaid reimbursement
  • Behavioral and mental health

A CLOSER LOOK

Finalized Legislation & Rulemaking:

  • In Pennsylvania, the governor signed SB 739, which amends Title 40 (Insurance) of the Pennsylvania Consolidated Statutes to require health insurers and Medicaid and CHIP managed care programs to provide coverage for healthcare services delivered through telemedicine using a HIPAA compliant technology. This bill establishes definitions related to telemedicine, as well as requirements for health insurance and Medicaid coverage of telemedicine services.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

  • Delaware issued a proposed rule to amend the Delaware Administrative code concerning professional counselors of mental health and chemical dependency professionals to clarify that face-to-face supervision or counseling includes live video conferencing.
  • Arizona issued a notice of rulemaking to notify of its intent to amend the Arizona Board of Behavioral Health Examiners rules to make them consistent with statutory changes including: (1) amending the definition of direct client contact to include therapeutic or clinical care via telehealth; (2) registration of out-of-state providers of telehealth services; (3) removing the requirements for evidence of indirect client hours obtained during training for social workers, counselors, marriage and family therapists, and addiction counselors; and (4) implementing the interstate compact for licensed professional counselors.

Why it matters:

  • States are increasing access to and coverage for telemedicine services. Pennsylvania expanded access to and coverage of telehealth services across insurance providers and across the state. Additionally, Delaware and Arizona are considering rules to include live video conferencing under the definition of direct patient care.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott Digital Health team works alongside the industry’s leading providers, payors and technology innovators to help them enter new markets, break down barriers to delivering accessible care and mitigate enforcement risk through proactive compliance.




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Trending in Telehealth: June 25 – July 1, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Interstate compacts
  • Medicaid reimbursement
  • Teledentistry
  • Professional standards
  • Behavioral and mental health

A CLOSER LOOK

Finalized Legislation & Rulemaking:

  • Rhode Island entered into the following compacts:
    • Social Work Licensure Compact (SB 2184)
    • Counseling Compact (SB 2183)
    • Speech-Language Pathology Interstate Compact (SB 2173)
    • Occupational Therapy Licensure Compact (SB 2623)
  • Louisiana enacted HB 888 which enters the state into the Social Work Licensure Compact.
  • In New Hampshire, the governor signed SB 411 which requires coverage of behavioral health or mental health crisis assessments, including both in-person and telehealth services for children and youth 21 years of age and younger.
  • In Illinois, the governor signed SB 1 which creates the Department of Early Childhood and transfers to it certain rights, powers, duties and functions currently exercised by various state agencies. The bill makes for provision of certain programs that have the ability to utilize telehealth as an option.
  • Ohio adopted a final rule that provides guidance from the Chemical Dependency Professional Board regarding the ethics and professional conduct of practice for certificate holders and licensees when using telehealth.

Legislation & Rulemaking Activity in Proposal Phase: 17

Highlights:

  • The Ohio Senate passed SB 211 that would enroll the state in the Dietitian Licensure Compact.
  • The Pennsylvania Senate passed SB 739 which would amend Title 40 (Insurance) of the Pennsylvania Consolidated Statutes to provide for telemedicine. This bill updates definitions related to telemedicine and requirements for health insurance and Medicaid coverage of telemedicine services.
  • The lower chamber in Pennsylvania passed HB 2268 which defines telehealth for speech language pathology and requires coverage by payors.
  • The upper chamber in Pennsylvania passed SB 913 which would require parental consent for virtual mental health services provided by a school entity.
  • The Delaware House passed SB 301 which would require public universities to provide access to medication to terminate pregnancy and emergency contraception, including requirements for accommodating a student’s request for a telehealth appointment if the student health center is not equipped or staffed to provide the medication.
  • In Puerto Rico, the Senate passed PS 1136 which would establish the Dental Examining Board of Dentists, Hygienists, Dental Assistants, Dental Technicians or Technologists and, among other things, develop a framework for teledentistry. The bill includes items on consent, patient information protection, definitions and other items related to teledentistry.
  • Mississippi published a proposed rule that amends the Department of Mental Health’s rules concerning assessments for persons receiving mental health services and/or substance use services to allow initial and subsequent visits to be provided [...]

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Trending in Telehealth: June 18 – 24, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Interstate compacts
  • Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking:

  • Arizona enacted SB 1036, entering into the Social Work Compact. Arizona is the 19th state to enact this compact.
  • Arizona also signed SB 1267 into law, which revises the definition of “general supervision” to include supervision through telehealth for physical therapy services provided by physical therapist assistants.
  • In Louisiana, the governor signed HB 896, the Louisiana Remote Patient Monitoring Program Law, which establishes a patient monitoring program including definitions, eligibility, and reimbursement requirements under Medicaid. It also addresses equipment and network requirements and availability, and is aimed at patients with costly, chronic illnesses. The act goes into effect August 1,
  • Nevada adopted a final rule that revises social work regulations, and now clearly states that licensed social workers are not allowed to provide telehealth services to a client outside of Nevada, unless authorized under that state’s laws.
  • Ohio partially adopted a rule regulating the provision of personal care activities, which includes documentation requirements when the care is provided by telehealth.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

  • New Hampshire passed to enter into the Social Work Compact. The bill heads to the governor’s desk.
  • Nevada proposed a rule that would revise optometry regulations and what is required of an optometrist before providing optometry services via telehealth, such as reviewing the patient’s chart and, if prescribing ophthalmic lenses, performing a manifest refraction.
  • Although not a formal rule, the Washington Insurance Commissioner is seeking feedback on amending telehealth-related rules. Specifically, the Office of the Insurance Commissioner (OIC) is considering consolidating healthcare regulations be consistent with state and federal changes. This would include amending definitions related to “established relationship” as it applies to audio-only telemedicine services. Interested parties can reach out to the OIC.

Why it matters:

  • Interstate compacts continue to grow. As we’ve seen consistently, states continue to join interstate compacts. This week, Arizona became the 19th state to enact the Social Work Compact, which New Hampshire introduced legislation to enroll into. Three other states have also introduced or fully enacted legislation to enroll in the Social Work Compact this year so far.
  • States are expanding the use of technology related to telehealth. Multiple states have legislation and regulations that account for difference in documentation when using telehealth or other technology, versus traditional in-person care. This week, Nevada a proposed rule that establishes standards of care specifically for providing optometry services via telehealth, and Ohio partially adopted a rule which factors in the automatic record creation of certain technologies. This push to incorporate technology is also evident in Louisiana’s passing of the Remote Patient Monitoring [...]

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Trending in Telehealth: June 11 – 17, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Interstate compacts
  • Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking:

  • In Florida, the governor signed H 7021, which revises substance abuse and mental health laws. This change allows for an individual to receive treatment via telehealth when a law enforcement officer determines involuntary examination is warranted.
  • Colorado enacted SB 24-141, which allows healthcare regulating bodies to create a telehealth registration process for out-of-state providers. A regulator must create the registration process, but an applicant is eligible for registration if the applicant (i) possesses an unencumbered out-of-state credential issued by another state that has educational and supervisory standards equivalent or exceeding Colorado’s standards or maintains the interstate compact license, (ii) has an agent of service in Colorado, (iii) has not been subject to disciplinary action in the last 5 years, and (iv) passes a jurisprudence examination.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

  • Rhode Island had a very active week passing compact-related bills. If signed by the Governor, Rhode Island will be enrolled in the:
    • Social Work Licensure Compact (SB 2184)
    • Counseling Compact (SB 2183)
    • Speech-Language Pathology Interstate Compact (SB 2173)
    • Occupational Therapy Licensure Compact (SB 2623)
  • The Ohio Senate also passed SB 28 that would enroll the state in the PA Licensure Compact.
  • Arizona bill SB 1036 would enact the Social Work Compact; it heads to the Governor’s desk.
  • Arizona also passed SB 1267 in both houses that would revise supervision requirements for physical therapy assistants, allowing for supervision via telehealth.
  • The Delaware Senate passed SB 301, which would require public universities to provide access to medication to terminate pregnancy and emergency contraception, including requirements for accommodating a student’s request for a telehealth appointment if the student health center is not equipped or staffed to provide the medication.

Why it matters:

  • Interstate compacts continue to grow. Although this week was relatively slow for telehealth-related legislation and rulemaking, interstate compact enrollments were the exception. States continue to pass compact-related legislation, with Rhode Island leading the charge this week with four bills passing both houses. Additionally, as we saw last week, states are also amending statutes and rules to accommodate compact providers. We see this in Colorado’s new telehealth registration under SB 24-141, the final version of which was amended from the original bill text to include compact providers.
  • Telehealth is playing a key role in program guidance. States continue to amend the rules and statutes related to various healthcare programs to account for the usage of telehealth. Ohio’s recently passed rule for homemaker services explicitly speaks to the difference in documentation [...]

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Trending in Telehealth: June 4 – 10, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Interstate compacts
  • Reimbursement requirements
  • Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking:

  • In Connecticut, the governor signed HB 5198, which permanently extends COVID-19 era telehealth provisions, originally set to expire at the end of this month. The bill also creates a registration requirement for mental and behavioral health providers who are providing care via telehealth from outside of the state. These providers do need to submit an application for licensure within 60 days of registration. The bill also addresses payment expectations for providers should a patient’s health insurance not cover telehealth services. Certain provisions went into effect immediately upon the governor’s signature, while others go into effect on July 1, 2024, after the existing provision expires.
  • Colorado enacted HB 24-1045, which addresses updates to treatment for substance use disorders generally and requires payment parity for telemedicine care of substance use under the state’s Medicaid program. This takes effect 90 days following the final adjournment of the state congress. Colorado also enacted SB 24-034, which expands school-based healthcare, allowing services to be provided via telehealth.
  • Illinois amended the Illinois Public Aid Code, through SB 3268, to include funding for the expansion of telehealth services in critical access hospitals with potential funding coming from the Department of Health Services (DHS) to support expansion. This also includes an amendment which states that beginning January 1, 2025, DHS will pay negotiated, agreed upon administrative fees associated with implementing telehealth services for persons with intellectual and developmental disabilities receiving Community Integrated Living Arrangement residential services.
  • Michigan enacted several telehealth related bills, all taking effect 90 days following the end of the congressional session:
    • HB 4131 :This bill updates the state’s private payor laws and requires, among other things, that there be payment parity and that health plans not limit telehealth-delivered services to only be provided via a third-party entity.
    • HB 4580: This bill will ensure coverage parity through Medicaid for telehealth services.
    • HB 4213: This bill will, among other things, require coverage of telehealth in the Medicaid program, including specifically allowing for audio-only and telehealth to be an eligible encounter for federally qualified health centers (FQHCs) and rural health clinics (RHCs).
    • HB 4579: This bill requires that all health plans cover telehealth services at the same rate as in-person care.
  • Nebraska’s enrollment in the Dietician Licensure and Physician Assistant Compacts took effect under LB 1215.
  • West Virginia finalized a rule that would expand the definition of Occupational Therapist and Occupational Therapist Assistant, to include those enrolled in the Occupational Therapist Compact.
  • Wyoming revised rules promulgated by the Medical [...]

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Trending in Telehealth: May 28 – June 3, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Interstate compacts
  • Reimbursement requirements
  • Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking:

  • In Colorado, SB 24-168 was signed by the governor, requiring reimbursement for remote monitoring for outpatient services for certain Medicaid members. This bill also creates a grant program to provide grants to outpatient healthcare facilities that are in rural areas to assist with the cost of providing telehealth remote monitoring, recognizing the cost to set up these programs. These parameters go into effect July 1, 2025. This bill also requires that the State cover continuous glucose monitors for Medicaid members.
  • Florida enacted HB 855, which addresses teledentistry treatment, specifically requiring a disclaimer to accompany dental care provided via telehealth that an in-person visit is recommended prior to telehealth treatment. The bill goes into effect July 1, 2024.
  • Mississippi finalized a rule that removed restrictions for telehealth visits with an evaluation & management code of level IV or V to be reimbursable by the state’s Medicaid program.
  • Tennessee enacted several telehealth related bills:
    • HB 2857: In the realm of general healthcare insurance statutes, the bill revises the definition of “provider-based telemedicine” in Tenn. Code Ann. § 56-7-1003 to remove the requirement that the patient has already established the provider-patient relationship via an in-person visit within 16 months prior to the telehealth visit. An in-person visit is still required, however it does not need to be within that 16-month lookback period. This bill took effect on May 28, 2024.
    • HB 2318: This bill allows a physician assistant who operates solely via telehealth to arrange for the required review of the physician assistant’s charts by a collaborating physician or any required visit by a collaborating physician to any remote site to be completed via HIPAA-compliant electronic means, rather than at the site of the clinic. The bill also removes telehealth as an option. This bill went into effect on May 28, 2024.
    • HB 2147: The Tennessee Medicaid Program, TennCare, is now required to cover complex rehabilitation visits that are conducted via telehealth. This goes into effect on July 1, 2024.
    • HB 2808: Tennessee now requires that healthcare services delivered to inmates for human immunodeficiency virus (HIV) treatment can be provided via telemedicine, if requested and associated payment through various state programs, including TennCare, to cover treatment. This bill goes into effect on July 1, 2024.
  • Vermont enacted a law through H 861 that requires parity for healthcare services provided via telemedicine, broadly applicable to healthcare insurance plans. This bill goes into effect on January 1, 2025.
  • Several states enacted compact-related legislation:



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Trending in Telehealth: May 21 – May 27, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Professional standards
  • Reimbursement requirements
  • Interstate compacts

A CLOSER LOOK

Finalized Legislation & Rulemaking

  • Connecticut enacted HB 5197, which enacts the Social Work Licensure Compact.
  • South Carolina enacted H 5183, which adds certain nursing tasks to the representative list of nursing tasks that may be delegated by a physician, physician assistant, or advanced practice registered nurse to unlicensed assistive personnel, including performing nonclinical tasks via telemedicine.
  • South Carolina also enacted S 610, which enacts the Counseling Compact.
  • The Wisconsin Psychology Examining Board amended its rules to bring them into alignment with the state’s establishment as a member of the Psychology Interjurisdictional Compact. Specifically, this adopted rule provides that the standards of practice and professional conduct apply to both telehealth and telepsychology services.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

  • In California, AB 2339 passed the first chamber. This bill would expand existing Medi-Cal definitions and exceptions that currently restrict the establishment of new patient relationships via telehealth. Specifically, this bill permits the use of asynchronous telehealth modalities to establish a new patient relationship when related to sensitive services or when requested by patient. For purposes of Medi-Cal, this bill expands the definition of “asynchronous store and forward” to include asynchronous electronic transmission initiated directly by patients, including through mobile telephone applications.
  • In Illinois, HB 5087 passed the second chamber. This bill would amend the Illinois Physical Therapy Act to provide that physical therapy through telehealth services may be used to address access issues to care, enhance care delivery or increase the physical therapist’s ability to assess and direct the patient’s performance in the patient’s own environment. This bill also provides that a physical therapist or a physical therapist assistant working under the general supervision of a physical therapist may provide physical therapy through telehealth services, subject to certain restrictions.
  • In Illinois, SB 2586 also passed the second chamber. This bill would amend the Illinois Dental Practice Act to include in the definition of teledentistry patient diagnosis and treatment planning services. This bill also provides practice standards by which a dentist may practice teledentistry, including that a dentist may only practice or utilize teledentistry on a patient of record and requires the dentist to obtain informed consent from the patient prior to rendering teledentistry services.
  • In Ohio, SB 95 passed the first chamber. This bill would permit remote dispensing pharmacies to dispense drugs, provide patient counseling and other pharmacist care through a telepharmacy system. This bill also specifies the requirements for a pharmacy to be eligible to operate as a remote dispensing pharmacy.
  • In Pennsylvania, SB 739 passed the first chamber. This [...]

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Trending in Telehealth: May 14 – May 20, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Reimbursement requirements
  • Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking

  • Iowa’s Board of Physical and Occupational Therapy amended two rules, Chapter 201, relevant to physical therapists and Chapter 208, relevant to occupational therapists. These rules establish standards for telehealth visits for physical therapy and occupational therapy, permitting the use of audio or video equipment, or both, at the discretion of the licensee. In connection with the adoption of the revised rules, the board noted that the expansion was a response to public comment from ATA Action, the American Telemedicine Associate’s affiliated trade association, which urged the board to expand the modalities that can be used for telehealth appointments in the interest of expanding Iowa patients’ access to affordable, high-quality healthcare.
  • Maryland enacted HB 1127, which authorizes certain healthcare providers to provide sexual assault forensic exams conducted through “peer-to-peer telehealth” without charge to victims and makes those services eligible for reimbursement by the Criminal Injuries Compensation Board (CICB). The peer-to-peer telehealth modality permits the performance of a forensic examination using interactive audio, video, or other telecommunications or electronic technology by a forensic nurse examiner to assist in the performance of a forensic examination when the forensic nurse examiner is in one location and the patient is with a qualified healthcare provider in another location.
  • Maryland also enacted HB 1078, which requires Medicaid to provide remote ultrasound procedures and remote fetal nonstress tests in certain circumstances.
  • South Carolina enacted S 858. This bill adds acute hospital care at home programs as exempt from Certificate of Need review by the SC Department of Health and Environmental Control. “Acute hospital care at home” includes the utilization of technology to provide continuous remote patient monitoring and connectivity to the patient.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

  • In Colorado, SB 24-054 passed the first chamber. The bill requires all private insurance companies to provide coverage for the treatment of the chronic disease of obesity and the treatment of pre-diabetes, including coverage for intensive behavioral or lifestyle therapy, bariatric surgery, and FDA-approved anti-obesity medication. The definition of intensive behavioral or lifestyle therapy includes interventions virtually through telehealth.
  • In Michigan, HB 4580 and HB 4213 passed the second chamber. If enacted, HB 4580 would require telemedicine services to be covered under Medicaid if the originating site is an in-home or in-school setting, in addition to any other originating site allowed in the Medicaid provider manual. HB 4213 would also require Medicaid to cover telemedicine services, however, further clarifies the requirements for Medicaid coverage. First, HB 4213 requires Medicaid coverage parity for telehealth services. Additionally, HB 4213 requires coverage of [...]

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